脉
脉弦而滑，两寸或浮而弦，或浮而滑，或沉而迟，或紧而洪，
或洪而数，或沉而迟，胸中寒饮。洪数者，热痰在膈间，时吐酸水，欲成翻胃之疾也。
病
丹溪曰∶吞酸与吐酸不同。吐酸，《素问》明以为热，东垣又言为寒，何也？吐酸，是吐出酸水如醋，
平时津液随上升之气郁积而成。郁积而久，温中生热，故从火化，遂作酸水吐出，非热而何？
其有积之以久，不能自涌而出，伏于肺胃之间，咯不得上，咽不得下。肌表得风寒，则内热愈郁，而酸味
刺心；肌表得温暖，则腠理开发。或得香热汤丸，津液得行，亦得暂解，非寒而何？《素问》言
热者，主其本；东垣言寒者，言其标也。
戴氏曰∶湿热在胃口上，饮食入胃，被湿热郁遏，其食不得传
化，故作酸也。如谷肉在器，湿热则易为酸也。
《原病式》曰∶吐酸者，肝木之谓也，由火盛制金，不能平木，
则肝木自盛，故为酸也。如饮食热则易于酸矣。必用 米菜蔬以自养，宜节浓味。
方
清郁二陈汤 治吞酸刺心及吞酸嘈杂。
陈皮（一钱） 半夏（一钱） 茯苓（一钱） 苍术（八分） 川芎（八分） 香附（一钱）
神曲（炒，五分） 枳实（炒，八分） 黄连（炒，一钱） 栀子（炒，一钱） 白芍（七分） 甘草（三分）
上锉一剂，生姜三片，水煎服，或为丸服，尤效。
茱莲丸 治郁积吞酸。
吴茱萸（去梗，汤泡浸半日，炒） 陈皮（去白） 黄芩（陈壁土炒，各五钱） 黄连
（陈壁土炒，一两） 苍术（米泔浸炒，七钱半）
上为末，神曲糊为丸。每服六七十丸，津液咽下。
苍连丸 治郁积吐酸。
苍术（米泔浸炒，一两） 陈皮（一两） 半夏（一两，姜汁炒） 黄连（一两半，夏月
倍用） 白茯苓（一两） 吴茱萸（炒，一两，冬月倍用）
上为末，蒸饼为丸，如绿豆大。每服三十丸，食后服。
曲术丸 治中脘宿食、留饮，酸螫心痛，口吐清水。
神曲（炒、三两） 苍术（米泔浸，一两半） 陈皮（一两） 加砂仁（一两）
上为细末，生姜汁，煮神曲糊为丸，如梧桐子大。每服七十丸，姜汤送下。
平肝顺气保中丸（云林制）〔批〕（按此方治吞酸、吐酸、嘈杂、嗳气兼治之剂）
治郁火伤脾，中气不运，胃中伏火，郁积生痰，致令呕吐，吞酸嘈杂，心腹胀闷。常服顺气和中，健脾开胃，
进美饮食，化痰消滞，清火抑肝。
香附米（三两，童便浸三日，炒） 川芎（二两） 陈皮（去白，三两） 白术（四两，
土炒） 浓朴（一两） 枳实（二两，炒） 黄连（姜汁炒，一两） 神曲（炒，二两） 麦芽（
炒，七钱） 木香（三钱） 栀子（姜汁炒，二两） 莱菔子（炒，一两） 半夏（姜汁炒，一
两半） 白茯苓（一两） 砂仁（炒，四钱） 干生姜（一两） 山楂（取肉，二两） 青皮
（六钱，香油炒） 甘草（炙，四钱）
上为末，竹沥打神曲糊为丸，绿豆大。每服百丸，食后白滚汤送下，日服二次。
Pulse
The pulse is wiry and slippery. The pulses at the cun position of both hands may be floating and wiry, or floating and slippery, or deep and slow, or tight and surging, or surging and rapid, or deep and slow, indicating cold-fluid retention in the chest. If the pulse is surging and rapid, it indicates hot-phlegm lodged between the diaphragm, with occasional regurgitation of sour fluid, which may develop into Fanwei disease (disease of vomiting and reflux).
Diseases
Zhu Danxi said: Tun-suan (acid regurgitation without vomiting) differs from Tu-suan (vomiting of acid fluid). Tu-suan is explicitly described as a heat syndrome in *Suwen* (Basic Questions), while Li Dongyuan describes it as a cold syndrome. Why? Tu-suan refers to vomiting sour fluid resembling vinegar. This occurs when normal body fluids accumulate due to stagnant ascending qi. After long-term stagnation, warmth generates heat within, transforming via fire, thus producing sour fluid that is vomited out. Is this not a heat syndrome? In cases where accumulation persists for a long time and cannot erupt spontaneously, lying latent between the lungs and stomach, unable to be coughed up or swallowed down: if the body surface is exposed to wind-cold, internal heat becomes more constrained, causing the sour taste to pierce the heart; if the body surface is kept warm, the couli (pores) open. Or, after consuming fragrant and hot decoctions or pills, body fluids circulate, providing temporary relief. Is this not a cold syndrome? When *Suwen* states "heat," it refers to the root cause; when Li Dongyuan states "cold," he refers to the branch manifestation.
Dai Shi said: Damp-heat resides above the gastric opening. When food enters the stomach, it is constrained by damp-heat, preventing proper transmission and transformation, thus generating acidity. It is like grain and meat in a vessel becoming sour easily under conditions of damp-heat.
*Yuan Bing Shi* (Treatise on the Origin of Diseases) states: Tu-suan belongs to Liver Wood pathology. It arises because excessive Fire controls Metal (Lung), failing to subdue Wood (Liver), leading to hyperactivity of Liver Wood, hence manifesting as sourness. Just as food becomes sour easily when heated. One must nourish oneself with rice and vegetables, and should moderate the intake of rich and strong flavors.
Formulas
Qingyu Erchen Tang (Clear Stagnation and Resolve Phlegm Decoction): Treats Tun-suan piercing the heart and Tun-suan accompanied by a sensation of hunger discomfort (zaoci).
Chenpi (Citri Reticulatae Pericarpium, 1 qian), Banxia (Pinelliae Rhizoma, 1 qian), Fuling (Poria, 1 qian), Cangzhu (Atractylodis Rhizoma, 8 fen), Chuanxiong (Chuanxiong Rhizoma, 8 fen), Xiangfu (Cyperi Rhizoma, 1 qian), Shenqu (Massae Fermentatae Medicinalis, stir-fried, 5 fen), Zhishi (Aurantii Fructus Immaturus, stir-fried, 8 fen), Huanglian (Coptidis Rhizoma, stir-fried, 1 qian), Zhizi (Gardeniae Fructus, stir-fried, 1 qian), Baishao (Paeoniae Radix Alba, 7 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen).
Crush these ingredients for one dose, add three slices of Shengjiang (Fresh Ginger), and decoct in water. Alternatively, prepare as pills for better efficacy.
Zhuolian Wan (Evodia and Coptis Pill): Treats Tun-suan caused by stagnant accumulation.
Zhuyu (Evodiae Fructus, remove stems, soak in boiling water for half a day, stir-fry), Chenpi (Citri Reticulatae Pericarpium, remove white pith), Huangqin (Scutellariae Radix, stir-fry with aged wall soil, each 5 qian), Huanglian (Coptidis Rhizoma, stir-fry with aged wall soil, 1 liang), Cangzhu (Atractylodis Rhizoma, soak in rice wash water, stir-fry, 7.5 qian).
Grind into powder, bind with Shenqu paste to form pills. Take 60–70 pills per dose, swallowing with saliva.
Canglian Wan (Atractylodes and Coptis Pill): Treats Tu-suan caused by stagnant accumulation.
Cangzhu (Atractylodis Rhizoma, soak in rice wash water, stir-fry, 1 liang), Chenpi (Citri Reticulatae Pericarpium, 1 liang), Banxia (Pinelliae Rhizoma, 1 liang, stir-fry with ginger juice), Huanglian (Coptidis Rhizoma, 1.5 liang, double dose in summer), Baifuling (Poria, 1 liang), Zhuyu (Evodiae Fructus, stir-fried, 1 liang, double dose in winter).
Grind into powder, bind with steamed bread dough to form pills, size of mung beans. Take 30 pills per dose, after meals.
Qushu Wan (Massa Fermentata and Atractylodes Pill): Treats retained food and lingering fluid in the Zhongwan region, sour-piercing heart pain, and spitting clear fluid.
Shenqu (Massae Fermentatae Medicinalis, stir-fried, 3 liang), Cangzhu (Atractylodis Rhizoma, soak in rice wash water, 1.5 liang), Chenpi (Citri Reticulatae Pericarpium, 1 liang), Sharen (Amomi Fructus, 1 liang).
Grind into fine powder, bind with ginger juice-boiled Massa Fermentata paste to form pills, size of sophora seeds. Take 70 pills per dose, delivered with ginger soup.
Pinggan Shunqi Baozhong Wan (Soothe Liver, Smooth Qi, and Protect Middle Pill) (Prepared by Yunlin) [Commentary]: This formula treats multiple conditions including Tun-suan, Tu-suan, zaoci, and belching.
Treats damage to the Spleen by stagnant fire, failure of Middle Qi to circulate, latent fire in the Stomach, and phlegm generation from stagnant accumulation, leading to vomiting, Tun-suan with zaoci, and abdominal distension and fullness. Regular use smooths Qi and harmonizes the Middle, strengthens the Spleen and opens the appetite, promotes digestion, resolves phlegm and stagnation, clears fire, and suppresses Liver hyperactivity.
Xiangfumiao (Cyperi Rhizoma, 3 liang, soak in urine of young boys for three days, stir-fry), Chuanxiong (Chuanxiong Rhizoma, 2 liang), Chenpi (Citri Reticulatae Pericarpium, remove white pith, 3 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang, stir-fry with soil), Houpo (Magnoliae Officinalis Cortex, 1 liang), Zhishi (Aurantii Fructus Immaturus, 2 liang, stir-fried), Huanglian (Coptidis Rhizoma, 1 liang, stir-fry with ginger juice), Shenqu (Massae Fermentatae Medicinalis, 2 liang, stir-fried), Maiya (Hordei Fructus Germinatus, 7 qian, stir-fried), Muxiang (Aucklandiae Radix, 3 qian), Zhizi (Gardeniae Fructus, 2 liang, stir-fry with ginger juice), Laifuzi (Raphani Semen, 1 liang, stir-fried), Banxia (Pinelliae Rhizoma, 1.5 liang, stir-fry with ginger juice), Baifuling (Poria, 1 liang), Sharen (Amomi Fructus, 4 qian, stir-fried), Ganshengjiang (Dried Fresh Ginger, 1 liang), Shanzha (Crataegi Fructus, flesh only, 2 liang), Qingpi (Citri Reticulatae Pericarpium Viride, 6 qian, stir-fry with sesame oil), Gancao (Glycyrrhizae Radix et Rhizoma, 4 qian, honey-fried).
Grind into powder, bind with bamboo sap and Massa Fermentata paste to form pills, size of mung beans. Take 100 pills per dose, delivered with plain boiled water after meals, twice daily.